Treatments for recurrent non–small cell lung cancer

Recurrent non–small cell lung cancer means that the cancer has come back after it has been treated. The following are treatment options for recurrent non–small cell lung cancer. Your healthcare team will suggest treatments based on your needs and work with you to create a treatment plan.

Treatment decisions are based on:

where the cancer has come back

what treatments have already been given

if the cancer has certain gene changes

your overall health

Chemotherapy

Chemotherapy may be offered for recurrent non–small cell lung cancer in people who are well enough to have this treatment.

If chemotherapy was not previously used as a treatment for non–small cell lung cancer, combination chemotherapy may be used.

The most common chemotherapy drug combinations used are:

cisplatin and etoposide (Vepesid, VP-16)

cisplatin and vinorelbine (Navelbine)

cisplatin and gemcitabine (Gemzar)

cisplatin and docetaxel (Taxotere)

carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol)

cisplatin and pemetrexed (Alimta) – not used for squamous cell types of non–small cell lung cancer

Single chemotherapy drugs may be used to treat a person with recurrent non–small cell lung cancer if they can’t have combination chemotherapy because of poor health or other medical conditions. A single chemotherapy drug may also be offered if cisplatin can’t be used anymore because of side effects.

Single drugs may also be used if combination chemotherapy has stopped working. The most common single drugs used for non–small cell lung cancer are:

gemcitabine

docetaxel

albumin-bound paclitaxel (Abraxane)

etoposide

irinotecan (Camptosar)

paclitaxel

pemetrexed – only used for adenocarcinoma types of non–small cell lung cancer

Targeted therapy

Targeted therapy is usually offered for non–small cell lung cancer that has come back after treatment. Different targeted therapy drugs may be offered in different situations.

Erlotinib (Tarceva) is offered if the cancer has come back after 2 or 3 different types of chemotherapy. This drug is offered whether the cancer is epidermal growth factor receptor positive (EGFR+) or not. It may also be offered as maintenance therapy for EGFR+ tumours after chemotherapy has finished.

Gefitinib (Iressa) or afatinib (Giotrif) may be offered for recurrent EGFR+ non–small cell lung cancer if targeted therapy has not been used before. Afatinib may also be given to people with squamous cell non-small cell lung cancer, if the cancer has stopped responding to chemotherapy.

Osimertinib (Tagrisso) may be offered for recurrent EGFR+ non-small cell lung cancer that has developed the T790M mutation, after being treated with other drugs that target EGFR+ tumours.

Crizotinib (Xalkori) may be offered for recurrent anaplastic lymphoma kinase–positive (ALK+) non–small cell lung cancer if it has not been used before.

Crizotinib may be offered for ROS1-positive non–small cell lung cancer if it has not been used before.

Ceritinib (Zykadia) or alectinib (Alecensaro) may be offered for ALK+ non–small cell lung cancer that has stopped responding to crizotinib.

Bevacizumab (Avastin) is an angiogenesis inhibitor that stops the growth of new blood vessels to the tumour. It may be offered in combination with carboplatin and paclitaxel for recurrent non–small cell lung cancer. If the cancer responds to the chemotherapy, it is continued by itself until the cancer starts to grow again.

Dabrafenib (Tafinlar) and trametinib (Mekinist) may be used in combination for advanced or metastatic non–small cell lung cancer with the BRAF V600E mutation that has stopped responding to chemotherapy.

Immunotherapy

Immunotherapy drugs are used with advanced or metastatic non–small cell lung cancer after it has stopped responding to chemotherapy or targeted therapy.

Nivolumab (Opdivo) may be offered for non–small cell lung cancer that has stopped responding to chemotherapy with cisplatin or carboplatin or has come back after chemotherapy. It may also be offered for EGFR+ and ALK+ recurrent non–small cell lung cancer that has stopped responding to targeted therapy.

Pembrolizumab (Keytruda) may be offered for recurrent non–small cell lung cancer that is PD-L1 positive and has stopped responding to chemotherapy with cisplatin or carboplatin. It may also be given for EGRF+ and ALK+ recurrent non–small cell lung cancer that has stopped responding to targeted therapy.

Endobronchial therapies

Endobronchial therapies are done inside the large airways of the lung (the bronchi) to remove a blockage and help with symptoms. They are used to treat and prevent symptoms caused by recurrent non–small cell lung cancer, such as coughing, problems breathing, bleeding and pain.

The type of endobronchial therapy used will depend on how quickly the symptoms must be treated.

Endobronchial therapies that quickly relieve symptoms are:

bronchial debridement

stent placement

laser surgery

electrocautery

Endobronchial therapies that work more slowly to prevent symptoms are:

photodynamic therapy (PDT)

cryosurgery – rarely used

Radiation therapy

External beam radiation therapy may be used for recurrent non–small cell lung cancer if it hasn’t been used as a treatment before. It may be offered to people who are not able to have chemotherapy to treat a recurrence in the lymph nodes in the chest or the lung and to relieve symptoms caused by the cancer (palliative radiation therapy). Radiation therapy may also be used to treat recurrent non–small cell lung cancer that has spread to the bones or the brain.

Brachytherapy may be used to treat a non–small cell lung cancer tumour that is blocking the large airways of the lung. The doctor places the radioactive isotope into the airways during a bronchoscopy (endobronchial radiation therapy).

Brachytherapy may be used as a primary treatment for people who cannot have external beam radiation therapy because of poor lung function.

Surgery

Surgery may be used to treat recurrent non–small cell lung cancer that has spread to the adrenal gland, brain or liver. For brain metastases, it is used when there is only one area of cancer found in the brain. For liver metastases, it may be offered if there is one area of cancer or a few areas of cancer found close together.

Surgery to remove a recurrence in the lung may be offered to people who are well enough to have surgery.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better rather than treat the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Clinical trials

You may be asked if you want to join a clinical trial for non–small cell lung cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

maintenance therapy

Treatment given after the first-line therapy (the first or standard treatment) to keep a disease (such as cancer) under control or to prevent it from coming back (recurring). It may be given for a long period of time.

Maintenance therapy may include drugs, vaccines, antibodies or hormones.

Taking action against all cancers

The latest Canadian Cancer Statistics report found that of all newly diagnosed cancers in 2017, half are expected to be lung, colorectal, breast and prostate cancers. Learn what you can do to reduce the burden of cancer.